Provider Demographics
NPI:1033360128
Name:GRANT PHARMACISTS GROUP
Entity Type:Organization
Organization Name:GRANT PHARMACISTS GROUP
Other - Org Name:TOTAL CARE PHARMACY#4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL RECORDS CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1606-845-3421
Mailing Address - Street 1:105 SPEARS LN
Mailing Address - Street 2:
Mailing Address - City:CRITTENDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41030-7513
Mailing Address - Country:US
Mailing Address - Phone:185-942-8090
Mailing Address - Fax:185-981-3132
Practice Address - Street 1:105 SPEARS LN
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-7513
Practice Address - Country:US
Practice Address - Phone:185-942-8090
Practice Address - Fax:185-981-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07274332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54002738Medicaid
KY4277860001Medicare NSC